What is the Dignity of Risk (DoR)?
​​The Dignity of Risk is the right to take risks as part of living a meaningful life. It recognizes that daily life is inherently uncertain and taking risks can lead to positive outcomes in quality of life, health, and well-being. Older adults often value maintaining autonomy (even if there is some risk associated) over being “kept safe”.
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For example, in current health care culture, there is often an emphasis on eliminating falls which can lead to immobility and greater harm for older adults living with frailty. Implementing a Dignity of Risk approach recognizes the benefits of mobility (and the harms of immobility) and shifts the narrative and practice culture to “how will we support mobility while mitigating risks”.
Equally as important is understanding how to communicate risk while coaching caregivers to help them move away from the often rigid thinking of “all or nothing safety”.
Most older adults want to remain at home as long as possible, including when living with frailty or dementia. The Dignity of Risk concept is essential to incorporate into approaches and practice by healthcare providers and caregivers, to optimize this goal of ageing in place.
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Understanding and implementing the Dignity of Risk into practice tends to empower healthcare staff to support reasonable and positive risk taking for older adult patients and clients.
Dignity of Risk Approach
Applying a Dignity of Risk approach to the care of older adults means grounding decisions in a clear understanding of:​
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What Matters Most to the older adult, even if living with cognitive impairment,
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The person’s frailty level, causes of frailty, and evidenced risks related to same,
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The intensity and type of caregiving in place,
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Caregivers’ sense of coping
It also calls for active reflection on biases such as ageism, overprotective attitudes, and the tendency to want to “keep them safe”. The Dignity of Risk approach can highlight potential blindspots where we may be removing autonomy and independence prematurely or unnecessarily.
Returning to our three 82-year-olds, their frailty levels differ significantly, shaping personalized care plans, caregiver coaching, and how Dignity of Risk can be meaningfully supported in each life:
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Connie lives in a nursing home, fully dependent for personal care. She enjoys standing and taking a few steps in her room to look at the view from her window (CFS 7: Living with Severe Frailty).​
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Fred lives at home with his wife and has mild dementia. He needs help with groceries, meals, and medications. He likes to go to the basement to look at and hold his workshop tools (CFS 5: Living with Mild Frailty).​
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Amanda lives at home independently and enjoys swimming twice weekly (CFS 2: Fit).
Dignity of Risk in Practice
Incorporating Dignity of Risk into everyday practice represents a meaningful behaviour change for healthcare teams. Many staff will naturally feel uncertain or uncomfortable with “the risk” unless they have been previously mentored, supported, or personally experienced this approach in their own lives.
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C-A Murray Consulting presentations and workshops offer a safe, exploratory space for staff to reflect on and discuss biases, healthcare cultural myths, practical challenges, and realistic solutions that can spark positive change in practice.
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By starting with something as simple as shifting our language, teams can use this as an initial motivator and stepping stone toward deeper, sustained change in how Dignity of Risk is applied in older adult care (click image to expand/download).
